Provider Demographics
NPI:1689497380
Name:PHILLIPS, TRANDI LYNETTE
Entity type:Individual
Prefix:
First Name:TRANDI
Middle Name:LYNETTE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8313 STILL MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-9752
Mailing Address - Country:US
Mailing Address - Phone:318-317-6710
Mailing Address - Fax:
Practice Address - Street 1:8313 STILL MEADOW DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-9752
Practice Address - Country:US
Practice Address - Phone:318-317-6710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-02
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty